Targeting guide with a radiopaque marker to facilitate positioning a bone plate on bone

ABSTRACT

Bone fixation system, including methods, apparatus, and kits, and comprising a bone plate and at least one instrument that attaches to the bone plate and provides at least one radiopaque region to facilitate positioning the bone plate on bone visualized by radiographic imaging. The instrument may be a handle assembly and/or a targeting guide.

CROSS-REFERENCES TO PRIORITY APPLICATIONS

This application is based upon and claims the benefit under 35 U.S.C.§119(e) of U.S. Provisional Patent Application Ser. No. 61/386,921,filed Sep. 27, 2010, and U.S. Provisional Patent Application Ser. No.61/390,120, filed Oct. 5, 2010, each of which is incorporated herein byreference in its entirety for all purposes.

INTRODUCTION

The radius (or radial bone) is one of two long bones found in the humanforearm. The radius, like other bones, is susceptible to a variety offractures and deformities. For example, distal fractures of the radiusare a common result, particularly among the elderly, of forward fallswith the palms facing downward. In such falls, force exerted on thedistal radius at impact frequently produces dorsal displacement of oneor more bone fragments created distal to the fracture site.

Fixation of the fractured radius may be performed by internal fixationwith a bone plate. The bone plate may be secured on the volar (ordorsal) surface of the distal radius with fasteners, such as bone screwsor K-wires, among others. The volar side of the radius may be moreaccessible surgically and defines a distal pocket in which a distalportion of the bone plate may be disposed. Accordingly, in some cases,the bone plate may be less obtrusive and may produce less tendonirritation with volar placement, even if the bone plate is thicker andsturdier. Bone plates for fixation of the distal radius on either thevolar or dorsal surface may include a narrower body portion disposedmore proximally on the radius and a wider head portion disposed moredistally.

Precise positioning of the bone plate on the radius (or other bone) maybe critical for successful fracture fixation, particularly when the endof the bone is fractured into many pieces. In particular, the trajectoryof each bone screw into bone is largely determined (variable-anglescrews) or completely determined (fixed-angle screws) by where the plateis positioned on the bone, and thus meticulous placement of the boneplate can make screw installation much easier and more effective.Accordingly, a surgeon may spend more time reducing a fracture andpositioning and re-positioning the bone plate on bone, than installingbone screws. For example, in some cases, a surgeon may spend about 45minutes reducing the fracture and achieving the desired placement of thebone plate on the radius and then only about 15 minutes securing thebone plate with bone screws.

A problem faced by surgeons when placing the bone plate on the boneprior to inserting screws is the tendency for the plate to shift whileprovisionally attaching it with one or more K-wires or clamps. Thisleads to errors in plate placement, for example, as a result of theplate pivoting and/or sliding. Errors in plate placement for the distalradius can cause screw trajectories to extend into unintended areas,such as into the joint distally or into soft tissue radially.

Surgeons use X-ray-based radiographic imaging, typically, video imaging(fluoroscopy), to monitor the location of the bone plate as it is beingmoved around on the bone. In orthopedic fluoroscopy, a beam of radiationtravels from an X-ray source along a beam axis (i.e., the viewing axis),through a target region of bone to be imaged, and then to a detectorbehind the target region that detects X-rays in a detection planetransverse to the beam axis. Differential absorption of the X-rays bythe bone, air, and the bone plate produces regions of contrast in theimages generated.

Instruments such as forceps or a bone clamp commonly are utilized tohold the bone plate in place during fluoroscopy before provisionallyattaching the plate to bone with K-wires or other fasteners. Thisapproach can prove difficult because forceps and bone clamps do notprovide a rigid attachment to the plate, so the bone plate may shift inposition. Also, surgeons do not want to place their hands in the fieldof view of the fluoroscope, to avoid exposure to X-rays. As a result,manual engagement of the bone plate during fluoroscopy is generally notpreferred.

It can be difficult to align the bone plate with features of the bone toachieve optimal plate position. One approach is to align a long axis ofthe bone plate with the long axis of the shaft of the bone. However, thebone plate may be relatively short and the bone may be wide and taperedwhere the bone plate is placed, which makes alignment of the plate andbone axes inaccurate.

Handles have been developed to facilitate positioning or stabilizing abone plate or an associated instrument, such as a guide device, for thebone plate. However, the handle generally is not designed properly toenable fluoroscopy-guided positioning and re-positioning of a bone plateon a target bone, and attachment of the bone plate when situatedproperly. For example, the handle may be unsuitable for fluoroscopybecause the handle is designed to be grasped too close to the plate,which places the surgeon's hand in the field of view and/or exposes thesurgeon's hand to excess radiation. Also, the handle may obscure orotherwise interfere with fluoroscopic viewing of the bone plate.Furthermore, the handle may fail to provide suitable orientationfeatures that enable a surgeon to select an informative fluoroscopicview of the bone plate and bone with confidence. The handle also mayfail to offer any alignment features for use when checking or adjustingthe alignment of the bone plate with bone, particularly if the handle isformed of plastic, which is generally radiolucent. Finally, the handlemay obstruct apertures of the bone plate, which prevents placement offasteners through the obstructed apertures while the handle is attached.

Plate position can determine screw trajectories from apertures of thebone plate into bone. However, surgeons can have difficulty predictinghow plate position will relate to screw trajectory without installingscrews. One approach for determining prospective screw trajectories isto provisionally attach the plate to bone, and then place wires throughapertures of the plate and into bone. The trajectories of the wires canbe visualized by fluoroscopy, which indicates the prospective paths ofbone screws placed coaxially with the wires. If the wire trajectoriesare acceptable, cannulated bone screws can be installed over the wires.However, if they are not acceptable, the wires must be removed, theplate re-positioned, and then the wires re-installed to check the newtrajectories. This trial-and-error approach can be slow and frustratingto the surgeon, and may damage bone and the joint.

A related trial-and-error approach may be used to place distal screws ina distal row of apertures of a bone plate for the distal radius. Asurgeon may have difficulty determining how far distally to place thebone plate on the volar bone surface. Distal screws should be introducedclose to the distal articular surface, while being certain that nodistal screws intersect the radiocarpal joint distally, the distalradioulnar joint ulnarly, or extend too far radially into soft tissue. Acommon method used to assess prospective screw placement distally is toplace K-wires through small holes in the plate and into bone to defineaxes that are coplanar with the most distal side of prospectivelyinstalled distal screws, then view the wrist under fluoroscopy in alateral to medial direction to determine if the K-wires are passing intothe joint or extend safely into bone. If an adjustment to plate positionis needed, the K-wires are removed, the plate position changed, and theK-wires re-installed and re-checked by fluoroscopy. This approach, likethe related approach described in the preceding paragraph, can betime-consuming and frustrating for the surgeon and damaging to bone.

The bone plate also may be secured with an obliquely-oriented styloidscrew(s) that extends into the radial styloid and locks to the plate ata fixed angle. Typically, distal screws are placed into the more distalapertures of the bone plate before the styloid screw is installed.Accordingly, if the styloid screw trajectory is undesirable, the platecannot be shifted in position to correct the styloid screw trajectorywithout taking out all of the distal screws. The surgeon thus may beforced to place a shorter screw or no screw into the radial styloid.

Instruments are needed to facilitate positioning a bone plate on boneunder fluoroscopy.

SUMMARY

The present disclosure provides a bone fixation system, includingmethods, apparatus, and kits, and comprising a bone plate and at leastone instrument that attaches to the bone plate and provides at least oneradiopaque region to facilitate positioning the bone plate on bonevisualized by radiographic imaging. The instrument may be a handleassembly and/or a targeting guide.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a top fragmentary view of selected aspects of an exemplarybone fixation system including a bone plate attached to a targetingguide and a handle assembly, with the bone plate disposed on a distalvolar surface region of a radial bone, shown in phantom outline, inaccordance with aspects of the present disclosure.

FIG. 2 is an isometric view of the bone fixation system of FIG. 1 withthe radial bone not shown.

FIG. 3 is a side elevation view of the bone fixation system of FIG. 1with the radial bone not shown.

FIG. 4 is a top view of the bone plate of FIG. 1, taken as in FIG. 1with the bone plate on a distal volar surface region of a fracturedradial bone, but with the targeting guide and handle assembly removed,and after attachment of the bone plate to the radial bone with a bonescrew received in a styloid aperture of a head portion of the boneplate, in accordance with aspects of the present disclosure.

FIG. 5 is a fragmentary cross-sectional view of the bone fixation systemof FIG. 1, taken generally along line 5-5 of FIG. 1 through the boneplate and the handle assembly.

FIG. 6 is a top view of the bone fixation system of FIG. 1, taken as inFIG. 1 with the bone plate on a distal volar surface region of a radialbone and assembled with the targeting guide but with a guide fastenerand the handle assembly removed.

FIG. 7 is an exploded view of the targeting guide of FIG. 1, takengenerally from above and to the side of the targeting guide.

FIG. 8 is a somewhat schematic side view of the targeting guide of FIG.6, taken generally along line 8-8 of FIG. 6.

FIG. 9 is another somewhat schematic side view of the targeting guide ofFIG. 6, taken along a line that is skewed slightly from line 8-8 of FIG.6.

FIG. 10 is a bottom view of the targeting guide of FIG. 6.

FIG. 11 is a fragmentary sectional view of the radial bone, bone plate,and targeting guide of FIG. 6, taken generally along line 11-11 of FIG.6 after placement of a guide tube into one of the openings of thetargeting guide, and with a drill bit about to be received in the guidetube, in accordance with aspects the present disclosure.

FIG. 12 is a somewhat schematic representation of an exemplaryradiographic image of the bone fixation system and radial bone of FIG. 1that may be generated by fluoroscopy using a radiation beam having abeam axis that is orthogonal to a plane defined by the bone plate, inaccordance with aspects of present disclosure.

FIG. 13 is a somewhat schematic representation of an exemplaryradiographic image of the bone fixation system and radial bone of FIG.1, taken generally along line 13-13 of FIG. 12 by fluoroscopy using aradiation beam having a beam axis that is orthogonal to the axes definedby distal markers of the targeting guide but skewed from a plane definedby the distal markers, in accordance with aspects of present disclosure.

FIG. 14 is a somewhat schematic representation of another exemplaryradiographic image of the bone fixation system and radial bone of FIG.1, taken generally along line 14-14 of FIG. 12 by fluoroscopy using aradiation beam having a beam axis that is orthogonal to the axes definedby distal markers of the targeting guide and parallel to a plane definedby the distal markers, in accordance with aspects of present disclosure.

DETAILED DESCRIPTION

The present disclosure provides a bone fixation system, includingmethods, apparatus, and kits, and comprising a bone plate and at leastone instrument that attaches to the bone plate and provides at least oneradiopaque region to facilitate positioning the bone plate on bonevisualized by radiographic imaging. The instrument may be a handleassembly and/or a targeting guide.

An exemplary bone fixation system is provided. The system may comprise abone plate including an outer surface region and defining a plurality ofapertures for receiving fasteners that secure the bone plate to bone.The system also may comprise a guide block attached or attachable to thebone plate with the guide block directly above the outer surface regionof the bone plate such that openings of the guide block are adjacent toand in coaxial alignment with apertures of the bone plate. The guideblock may include a radiolucent body that defines the openings and alsomay include at least one elongated, radiopaque marker affixed to theradiolucent body.

Another exemplary bone fixation system is provided. The bone fixationsystem may comprise a bone plate including a head portion and anelongated body portion. The head portion may have an outer surface andmay define a plurality of apertures for receiving fasteners that securethe bone plate to bone. The bone fixation system also may comprise aguide block attached or attachable to the bone plate with the guideblock directly above the outer surface region of the head portion suchthat openings of the guide block are adjacent to and in coaxialalignment with apertures of the head portion. The guide block mayinclude a one-piece, radiolucent body that defines the openings and alsomay include at least one elongated, radiopaque marker affixedsubstantially permanently to the radiolucent body.

An exemplary method of bone fixation is provided. In the method, a boneplate may be disposed on a bone. The bone plate may include an outersurface region and may define a plurality of apertures. One or moreradiographic images may be generated of the bone, with the bone platedisposed on the bone and attached to a guide block, with the guide blockover the outer surface region such that openings of the guide block areadjacent to and in coaxial alignment with the apertures of the boneplate. The guide block may include a radiolucent body that defines theopenings and at least one elongated, radiopaque marker disposed in andaffixed to the radiolucent body. A position of the bone plate may beadjusted on the bone based on a position of the at least one marker withrespect to the bone in the radiographic image. The bone plate may besecured to the bone.

The targeting guide, structured as a guide block, may be perforated todefine a plurality of openings through which bone may be drilled and/orfasteners may be placed. The targeting guide may be configured to beassembled with the bone plate, with the openings in coaxial alignmentwith apertures of the bone plate. In some embodiments, the bone platemay include an outer surface region over which the targeting guide isattached to the bone plate. The outer surface region may be provided bya portion of the bone plate, such as one of a pair of anchor portions.The anchor portion may be a distal portion of a bone plate and/or a headportion of a bone plate including the head portion and a stem portion.

The guide block may include a perforated block or body and one or moremarkers attached to the body. Each marker may be disposed in the body,for example, such that at least a majority (or at least substantiallyall) of the marker is contained by the body. In other words, the markermay not project substantially above and/or below the targeting guide.Each marker may be a pin. The body and the markers may differ in theirradiopacity (i.e., the extent to which they block ionizing radiation)and thus in their ability to be visualized by imaging with ionizingradiation, generally X-rays. For example, the body of the guide may beradiolucent, while the markers may be relatively radiopaque.Accordingly, with this arrangement, the markers may be readily visiblein X-ray images because they contrast with the guide body, and,optionally, with the bone plate.

Each marker may have any suitable disposition with respect to thetargeting guide and/or attached bone plate. For example, the targetingguide may include a pair of markers that collectively define aproximal-distal boundary plane through bone to indicate the distalextent of prospectively placed distal bone screws and/or that indicatemedial and lateral boundaries for prospective placement of the distalscrews in bone. Alternatively, or in addition, the targeting guide mayinclude a marker that forms a line segment in an X-ray image takenorthogonal to the outer surface region of the bone plate. The linesegment may be oriented obliquely to the long axis and a width axis ofthe bone plate, and/or may point to an anatomical landmark on the bonein a radiographic image when the bone plate is correctly positioned onthe bone.

An exemplary method of bone fixation is provided. In the method, ahandle assembly may be fastened to a bone plate defining a long axis.The handle assembly may include an extension portion connected to agraspable grip portion. The extension portion may provide a radiopaquealignment region that is offset from the bone plate along the long axis.One or more radiographic images may be generated of the alignment regiondisposed above a shaft portion of a long bone while the bone plate isdisposed on an end portion of the long bone that is wider than the shaftportion. An orientation of the bone plate on the long bone may beadjusted based on a relative alignment of the alignment region and theshaft portion in the radiographic images. The bone plate may be securedto the long bone. The handle assembly may be disconnected from the boneplate.

Another exemplary method of bone fixation is provided. In the method, abone plate may be selected. The bone plate may include a head portionconnected to an elongated body portion. The body portion may be narrowerthan the head portion and may define a plane and a long axis. A handleassembly may be fastened to the bone plate. The handle assembly mayinclude an extension portion connected to a graspable grip portion. Theextension portion may provide a radiopaque alignment region that isoffset from the bone plate along the long axis in a direction away fromthe head portion. Radiographic images of the alignment region disposedabove a shaft portion of a long bone may be generated while the boneplate is disposed on an end portion of the long bone and using a beam ofradiation having a beam axis oriented substantially orthogonal to theplane of the bone plate. The alignment region may be positioned to besubstantially parallel to the shaft portion of the long bone in one ormore of the radiographic images. The bone plate may be secured to thelong bone. The handle assembly may be disconnected from the bone plate.

Yet another exemplary method of bone fixation is provided. In themethod, a bone plate and a handle assembly may be selected. The boneplate may include a head portion connected to an elongated body portion.The body portion may be narrower than the head portion and may define along axis. The handle assembly may include a base portion, a graspablegrip portion, and an extension portion connecting the grip portion tothe base portion. The extension portion may provide a radiopaquealignment region. The bone plate may be fastened to the handle assemblyat the base portion with at least one threaded fastener. The bone platemay be disposed on end portion of a long bone and the alignment regionabove a shaft portion of the long bone, with the alignment region andthe shaft portion defining respective long axes that are substantiallycoplanar to each other. The bone plate may be secured to the long bone.The handle assembly may be disconnected from the bone plate.

The handle may be rigidly attachable to the bone plate and, due to itslength and shape, may allow a surgeon to make precise changes in plateposition on bone prior to provisional or final fixation with K-wiresand/or screws. The handle also may permit the surgeon to manipulate thebone plate remotely, with less X-ray exposure to the surgeon's handsduring fluoroscopy, because the grasped portion of the handle is outsidethe fluoroscopic field. Also, the handle may enable better and quickeralignment of the bone plate with bone, easier determination of whetherthe fluoroscopic view is orthogonal to the bone plate and/or transverseto the bone (e.g., medial-lateral) or bone plate, and installation ofone or more fasteners where the handle may be laterally offset from thebone plate. The same handle also may be designed to clear soft tissueand the incision when used on right or left plates.

Further aspects of the present disclosure are described in the followingsections: (I) overview of an exemplary bone fixation system, (II)exemplary bone plate, (III) exemplary handle, (IV) exemplary targetingguide, (V) composition of system components, (VI) methods of bone platepositioning, attachment to bone, and bone fixation, (VII) kits, and(VIII) examples.

I. OVERVIEW OF AN EXEMPLARY BONE FIXATION SYSTEM

FIGS. 1-3 show various views of an exemplary bone fixation system 50including a bone plate 52 fastened to a targeting guide 54 and a handle56 (also termed a handle assembly) using respective fasteners 58, 60.Guide 54 and handle 56 may function as instruments that each provide atleast one radiopaque region to facilitate positioning the bone plate ona bone visualized by radiographic imaging. The guide and/or handle alsoor alternatively may be used to facilitate placement of fasteners intobone and/or for holding and moving the bone plate, among others.

The bone fixation system, and particularly bone plate 52, may bedisposed on a bone 62. In FIG. 1, bone 62 is shown in phantom outlineand is a long bone, namely, a radial bone 64. Bone plate 52 may, forexample, be disposed on a distal volar (or dorsal) surface region 66 ofradial bone 64. However, the fixation system may be configured for usewith any suitable bone.

In any event, the bone plate may be placed on the bone, and the positionof the bone plate determined and/or inferred by radiographic imaging,such as fluoroscopy, with the aid of one or more radiopaque regions ofguide 54 and/or handle 56. The bone plate may be re-positioned on thebone if desired, based on one or more radiographic images that show theradiopaque region(s), and optionally by manipulating handle 56.Fasteners then may be installed, optionally with the aid of targetingguide 54, to secure the bone plate to bone. For example, the targetingguide may be used directly to guide a drill bit, a fastener, and/ordriver and/or may be utilized to hold one or more guide tubes that guidea drill bit, a fastener, and/or a driver, among others. In any event,each of guide 54 and handle 56 may be disconnected from the bone plateand removed after (or before) the bone plate is secured to bone. Furtheraspects of the radiopaque regions of the guide and handle and their usein bone plate installation are described below.

II. EXEMPLARY BONE PLATE

FIG. 4 shows bone plate 52 disposed an end portion of a bone, namely, onvolar surface region 66 of a distal part of radial bone 64. The boneplate may be attached to the bone with fasteners, such as bone screws,but to simplify the presentation, only one bone screw 70 is shown here.Guide 54 and handle 56 have been disconnected and removed.

The bone plate may have a proximal portion 72 connected to a distalportion 74, with the proximal and distal portions arranged along thebone plate from each other. In use, each of the proximal and distalportions of the bone plate may function as anchor portions disposed onopposing sides of a bone discontinuity, such as a fracture 76, with thebone plate spanning the discontinuity. The proximal and distal portionsof the bone plate may provide respective attachment sites for targetingguide 54 and handle 56. Also or alternatively, the bone plate may have arelatively wider head portion 78 connected to a relatively narrower,elongated body portion 80. The head portion may be configured to bedisposed distal to the body portion on bone, or vice versa.

The bone plate or a portion thereof may define a long axis 82. In boneplate 52, body portion 80 defines long axis 82. The bone plate may bendupward or downward, away from the long axis as it extendslongitudinally. For example, bone plate 52 bends upward from long axis82 as it extends from the body portion to the head portion (e.g., seeFIG. 3). Body portion 80 and/or an inner and/or outer surface region 83,84 thereof may define a plane 86 (see FIG. 5), such as a center-of-massplane for the body portion that contains long axis 82. The plane may beat least generally parallel to inner and outer surface regions 83, 84 ofthe body portion and/or may be at least generally tangential to innersurface region 83 or outer surface region 84. An orthogonal plane 88 maycontain long axis 82 and be orthogonal to plane 86 (see FIG. 5), toconceptually divide body portion 80 and/or bone plate 52 into at leastapproximate halves.

The bone plate may have an inner surface region 90 (see FIGS. 3 and 5)that is contoured to substantially match a surface region of a targetbone such that the bone plate fits onto the bone. The head portion ofthe bone plate may provide the contoured inner surface region. In somecases, head portion 78 may provide an inner surface region contoured tosubstantially match and/or fit onto a distal surface region of a radialbone or a tibial bone, among others. The inner surface region may, forexample, function as a template to assist a surgeon in bonereconstruction near the end of a bone, such as when the bone isfragmented into several or more pieces.

Bone plate 52 may define a plurality of apertures of the same ordifferent size (see FIG. 4). Each aperture may or may not includelocking structure, such as an internal thread, to lock a fastener to theaperture. Also, each aperture may be used with a toggle fastener or afixed-angle fastener. The apertures may include apertures 102-116defined by head portion 78 and body portion 80 of the bone plate toreceive narrower and wider bone screws, respectively. Aperture 110 maybe configured to receive styloid screw 70 that extends into radialstyloid 122 of the radial bone. Aperture 116 additionally may beutilized to provide threaded engagement of handle fastener 60 with thebone plate (see FIGS. 4 and 5), and any of apertures 102-114 may beutilized for the same purpose with guide fastener 58 (e.g., see FIG. 1).The bone plate also may include smaller apertures 124 to receive wires.The bone plate further may define at least one elongate aperture or slot126 to facilitate plate repositioning when the bone plate is connectedto bone only with a screw in aperture 126 and/or to provide compression.The bone plate also may define an access port 128 to facilitatemanipulation of underlying bone, such as movement of bone fragmentsand/or addition of a bone graft through the port. The access port alsomay be used to facilitate mating of bone plate 52 with guide 54, asdescribed below in Section IV.

The bone plate may be equipped with a provisional or interim retainer orcleat 130 that protrudes from an inner surface of bone plate 52. Thecleat may be continuous with a plate body that forms the inner surface,that is, the cleat may be formed integrally or monolithically with theplate body. The cleat may taper away from the plate body and may be atleast generally pointed in profile, to form a prong. In any event, thecleat may be configured to permit bone plate 52 to slide on bone (e.g.,with guide 54 and handle 56 attached; see FIG. 1) until the cleat isurged against bone, to provide an anti-slip function until a provisionalfastener can be installed to better stabilize bone plate position. Thecleat may slide along a surface region of bone with the bone plate,while the bone plate is being moved into a desired position on bone, andthen may form and occupy an indentation in bone to stabilize the currentplate position, by resisting plate slippage. The cleat may be urged intobone by applying pressure to the bone plate toward bone using asurgeon's hand (e.g., pushing on the bone plate with a finger or thumb),with a separate tool, with handle 56, or the like. The cleat may beminiature in size, which may avoid a substantial effect on how the boneplate fits and slides on bone before the cleat is urged into bone, mayminimize damage to bone, and/or may facilitate removing the cleat frombone when the plate is to be moved. The miniature cleat may project fromthe body of the bone plate by substantially less than the thickness ofthe bone plate, such as less than about one-half the thickness of thebone plate. Further aspects of an exemplary cleat that may be suitableare described in U.S. Provisional Patent Application Ser. No.61/390,120, filed Oct. 5, 2010, which is incorporated herein byreference.

III. EXEMPLARY HANDLE

FIGS. 1-3 and 5 show various aspects of handle 56. The handle mayinclude an attachment or base portion 140, an extension portion 142, anda graspable grip portion 144, among others.

Base portion 140 may include a bracket 146 that engages bone plate 52(see FIGS. 1-3 and 5). The base portion and/or bracket 146 may be atleast generally U-shaped. Base portion 140 may define one or moreopenings 148-154 that overlap and/or are co-axial with apertures of thebone plate (see FIG. 1).

Fastener 60 may be received in opening 148 to attach handle 56 to boneplate 52 (see FIG. 5). The handle fastener may have an external thread160 formed near its distal end for threaded engagement with an internalthread of aperture 116 of bone plate 52 (also see FIG. 4). A shoulder162 may be formed proximal to the external thread. The shoulder may actas a stop that engages bracket 146 adjacent opening 148, to blockthreaded advancement of fastener 60 into the bone plate. A proximalshaft 164 may extend to a graspable head 166 of the fastener thatprovides a knurled surface 168 to resist slippage during manualengagement. Fastener 60 (and/or fastener 58) may be described as athumbscrew, namely, a threaded fastener configured to be turned by hand.

Handle 56 may be configured to be attached to both left-side andright-side versions of bone plate 52 (to fix left and right radialbones), using handle fastener 60. Accordingly, base portion 140 may bedesigned to provide alignment of openings 148-154 (see FIG. 1) with boneplate apertures of both left and right versions of bone plate 52. Inparticular, any of the openings of the base portion may be elongated(e.g., opening 148) or duplicated (e.g., openings 150 and 152) toaccommodate lateral shifts in the position of non-centered apertures(e.g., aperture 116) between left and right bone plates. Opening 148 mayhave a keyhole shape that permits handle fastener 60 to be retained inthe narrower portion of the keyhole whether or not the fastener isattached to the bone plate.

Bracket 146 may define a socket 170 to receive an end of extensionportion 142 of the handle. The extension portion may be affixed to thebracket in the socket.

The inner surface of bracket 146 may define a cavity 172 to receive aregion of the bone plate. Thus, the base portion and bone plate may havecomplementary engagement surfaces for mating with one another.

Extension portion 142 may extend from base portion 140 to grip portion144 (see FIGS. 1-3). The extension portion may be described as a stem ora shaft, which connects to a head (grip portion 144). The extensionportion may extend along a nonlinear path, which may bend at least onceor two or more times, at least generally above and to a positionlongitudinally beyond an end of the bone plate. The extension portionmay form an elevation region 180 extending upwardly and, optionally,obliquely (e.g., in a lateral direction) from the bone plate and alsomay form an offset region 182, which may extend parallel to long axis 82of the bone plate (see FIG. 1) but not directly above the long axis(i.e., laterally offset from the bone plate). The extension portionfurther may form a transverse region 184 extending back to a positiondirectly above the bone plate, an alignment region 186, and a gripinterface region 188, among others. A first structure that is “directlyabove” a second structure is arranged above the second structure on avertical or orthogonal axis that extends from the second structure tothe first structure, with or without at least one other structuredisposed between the first and second structures.

Any suitable region or all of extension portion 142 may be radiopaque topermit radiographic visualization, such as by fluoroscopy. For example,transverse region 184 and/or alignment region 186 may be radiopaque. Inexemplary embodiments, extension portion 142 may be formed of metal,such as stainless steel. The extension portion may be a bent cylinderand/or at least generally round in cross-section. Also, the alignmentregion may be cylindrical. In some embodiments, a body of the extensionportion may be formed of a radiolucent material, such as plastic, havinga radiopaque insert (e.g., an embedded metal wire) or covering (e.g., ametal sleeve).

The term “radiopaque” means relatively efficient at blocking X-rays. Astructure that is radiopaque is formed of a material that is better atblocking X-rays than bone and generally contrasts with overlapped bonein radiographic images. The term “radiolucent” means substantially lessefficient at blocking X-rays than something that is radiopaque. Astructure that is radiolucent may be formed of a material that does notblock X-rays as well as bone and may be less visible than bone (and/orsubstantially invisible relative to overlapped bone) in radiographicimages.

Handle 56 may be structured to define one or more axes that are parallelto one or more characteristic axes defined by the bone plate (see FIGS.1-3). For example, the handle may define a shaft-alignment axis 200oriented parallel and/or coplanar to long axis 82 defined by the boneplate, and/or parallel to and/or disposed in orthogonal plane 88. Also,the handle may define a transverse axis 202 oriented parallel to a widthaxis 204 (another transverse axis) defined by the bone plate. Further,the handle may define a z-axis 206 oriented parallel to a height orthickness axis of the bone plate. Z-axis 206 may be defined as an axisthat is positioned at a junction 210 of transverse region 184 andalignment region 186 and that is mutually orthogonal to shaft-alignmentaxis 200 and transverse axis 202 (see FIG. 2). Accordingly, the handlemay define a set of orthogonal axes related translationally tocharacteristic axes of the bone plate. Each of axes 200, 202, 206 may beassignable in a radiographic view of the handle alone and/or the handleattached to the bone plate.

Alignment region 186 may (or may not) be substantially narrower than thebone plate. For example, the alignment region may be no more than aboutone-half or one-fourth as wide as body portion 80 of the bone plate,which may be closest to the alignment region. A relatively narrowalignment region may be advantageous to reduce weight and cost, tominimize obstruction of other structures (e.g., bone, the bone plate,and fasteners) during fluoroscopy, and to define a more clearlydiscernable alignment axis.

The alignment region may be elevated with respect to body portion 80 andoffset from body portion along long axis 82 in a direction away fromhead portion 78. Alignment region 186 may be offset any suitabledistance such as at least about one-half the length of the alignmentregion.

A typical long bone, such as radial bone 64, is relatively wider nearits proximal and distal ends. Accordingly, a surgeon may have difficultydetermining whether a bone plate placed on an end portion of a long boneis aligned with the shaft of the bone. Alignment region 186 may be usedto facilitate alignment of the long axes of the bone plate and the bone,for example, alignment of long axis 82 defined by body portion 80 of thebone plate with a long axis 212 defined by a shaft portion 214 of thebone (see FIG. 1). For this purpose, the bone may be viewedfluoroscopically using a beam axis that is orthogonal to bone plate 52(e.g., with the bone viewed parallel to axis 206 (see FIGS. 2 and 3),such as in an anterior-posterior view (see FIG. 1)). Alignment region186 may be disposed more centrally along the bone relative to the boneplate, such that the alignment region is above a narrower region of thebone. Use of the alignment region above a narrower region of the boneallows the surgeon to more easily and accurately determine whether thealignment region is centered over the bone shaft.

Alignment region 186 may be elevated above bone and thus with respect tobone plate 52 (e.g., see FIGS. 2 and 3). Accordingly, views of the boneplate and the alignment region taken obliquely to bone plate 52,particularly skewed from orthogonal to plate 52 about an axis parallelto long axis 82, do not position the alignment region and the bone platecoaxial to each other in radiographic images. (If alignment region 186is parallel to long axis 82, region 186 and the bone plate may beparallel and laterally offset from each other if the view is skewed.) Toensure proper orientation of the beam axis to provide a view orthogonalto the bone plate, the bone plate and handle may form a radiographicallyvisible juxtaposition of a landmark 220 of extension portion 142 with anedge feature 222 of bone plate 52, to signify that the beam axis issubstantially orthogonal to the plane of the bone plate (see FIG. 1 andEx. 1). Here, landmark 220 is junction 210 formed by a bend (e.g., aright-angle bend) where transverse region 184 and alignment region 186meet (see FIG. 2). More generally, landmark 220 may be a bend in theextension portion, a change in width of the extension portion, anaperture of the extension portion, or a combination thereof, amongothers. In any event, the landmark may be formed along extension portion142 at a position that is directly above edge feature 222 of the boneplate. The edge feature may be a site on the outer edge of the boneplate (forming a perimeter of the bone plate) or a site on one of aplurality of inner edges that bound apertures of the bone plate. In thepresent illustration, landmark 220 is configured to be superimposed, inradiographic images, on edge feature 222 formed at one end of the boneplate. In use, a surgeon may adjust the position of the bone (and/or thebeam axis) until landmark 220 of handle 56 and edge feature 222 of boneplate 52 are close or overlap in radiographic images, to ensure asubstantially orthogonal view (or other predefined view) of the boneplate (and/or bone).

Handle 56 may travel a circuitous route from base portion 140 toalignment region 186, particularly if base portion 140 is disposed on alongitudinally central region of the bone plate. In particular, offsetregion 182 may be offset laterally above the bone plate, rather thanbeing positioned directly above the bone plate (e.g., see FIG. 1). Theoffset region thus may follow a path that avoids obstructing aperturesof the bone plate, which permits fasteners to be placed into theapertures while the handle is still attached. For example, a surgeon mayplace a bone screw through aperture 118 or slot 126 (see FIG. 4) whilethe handle remains attached to the bone plate. Attachment of the handleto the central region of the bone plate (e.g., via bone plate aperture116), rather than near the end of the bone plate, may be advantageous tominimize the length of the incision and/or to provide finer control overbone plate position via handle manipulation.

FIG. 3 shows a side view of the bone fixation system 50, taken parallelto transverse axes 202, 204 defined by the bone plate and the handle(see FIG. 1). At least two of offset region 182, transverse region 184,and alignment region 186 may define coplanar axes, which collectivelydefine a plane. In FIG. 3, the plane defined by these coplanar axes isoriented orthogonally to the plane of view. In any event, the positionsof any of these regions may be used by a surgeon during fluoroscopy toselect a transverse view of the bone plate, such as by adjusting thebeam axis until transverse region 184 is viewed end-on. Accordingly,regions 182-186 may be used to, for example, facilitate generating anaccurate medial-lateral view of the radial bone during fluoroscopy.

Grip portion 144 may be sized to be grasped by a person's hand (glovedor ungloved). Accordingly, the grip portion may be substantially widerthan extension portion 142 of the handle, such as at least about 2, 3,or 5 times wider. The grip portion may be disposed in a longitudinallyspaced and elevated relation to the bone plate, such that the gripportion (and a hand grasping the grip portion) can stay away from theX-ray beam of an imaging device during use of the handle. Thus, the gripportion may be disposed above an intact region of skin at a positionremote from the bone plate during use. In other words, the handle mayprovide clearance above soft tissue when the handle is being utilized toposition the plate. The grip portion may be connected to extensionportion 142 by any suitable mechanism, such as a set screw, a press fit,threaded engagement, an adhesive, bonding, or the like.

IV. EXEMPLARY TARGETING GUIDE

FIGS. 6 and 7 show respective intact and exploded views of targetingguide 54. In FIG. 6, bone plate 52 is assembled with guide 54 on radialbone 64, as in FIG. 1, but handle 56 and fasteners 58, 60 are not shown.In this view, guide 54 is disposed over an outer surface region 240 ofhead portion 78 of bone plate 52, with the guide substantially coveringthe head portion and in contact with outer surface region 240. The guidemay be disposed selectively over the head portion relative to the bodyportion of the bone plate.

Targeting guide 54 may be structured as a guide block 250 equipped withone or more radiographic markers 252-256 attached to a perforated body258. The body may be a single piece. The markers may be used viaradiographic imaging, such as during fluoroscopy, to check, monitor, andimprove the position of a bone plate on bone.

Body 258 may define a plurality of openings that correspond in size andposition to apertures of the bone plate. (The terms “opening” and“aperture” are interchangeable in the present disclosure.) The openingsmay be collectively arrangeable in coaxial alignment with apertures ofthe bone plate. In the present illustration, the openings are sized incorrespondence with, and arrangeable in coaxial alignment with apertures102-114, smaller holes 124, and access port 128 of head portion 78 ofbone plate 52 (compare FIG. 4 with FIGS. 6 and 7). For example, smallerdistal openings 260 of the guide block (see FIG. 7) may be aligned withsmaller distal apertures 124 of the bone plate (see FIG. 4), to allowplacement of wires through the guide block and the bone plate. Also,larger openings 262-268 of the guide block may assist in guiding a drillbit and/or a bone screw into aligned bone plate apertures, such as byreceiving and holding a guide tube. The larger openings may includedistal openings 262-265 that facilitate installation of distal fastenersin a row of distal apertures 102-108, respectively. The larger openingsalso may include an ulnar opening 266, and dual styloid openings 267,268 that are contiguous and facilitate installation of styloid screw 70and another screw through apertures 110, 112 and into the radial styloid(see FIGS. 4 and 7). The guide block further may be equipped with alargest opening 270 that corresponds in size, shape, and position toaccess port 128 of the bone plate.

Each marker may be affixed to the body before the guide block isattached to the bone plate. Each marker may be integral to the guideblock, meaning that the marker is disposed in and affixed substantiallypermanently to body 258 such that the marker cannot be removed readilyfrom the guide block. The marker may be contained at least substantially(or completely) in the body. For example, the marker may not projectsubstantially (or at all) from an outer surface 272 and/or an innersurface 274 of body 258 (see FIGS. 7 and 8). A marker that does notproject substantially projects by a distance that is no more than about20% or 10% of the thickness of the body and/or has less than about 20%or 10% of the marker's total length projecting from the body. In anyevent, the marker may remain completely outside bone during use.

Each marker may be radiographically distinguishable from body 258, suchthat the marker is visible in radiographic images (e.g., collected byfluoroscopy). For example, the marker may be radiopaque and the bodyradiolucent, or vice versa. In exemplary embodiments, the marker may beformed of metal and the body of plastic. In some embodiments, the bodymay be radiopaque (e.g., formed of metal) and the marker(s) may beradiolucent and formed by at least one opening or radiolucent insert inthe body.

Each marker may extend adjacent to at least one opening of guide block250. However, the marker may not be co-axial with any of the guideopenings that accept bone screws. The marker and its adjacent,corresponding opening may define respective axes that are substantiallyparallel to and spaced from each other or substantially coplanar to eachother, among others. In any event, with a suitable radiographic view,the marker may allow a surgeon to predict a prospective fastenertrajectory into bone. The use of a targeting guide with one or moreradiopaque markers may permit the prospective trajectories of one ormore fasteners to be predicted more quickly, via fluoroscopy, as thebone plate is being positioned on bone, and without the need for thelabor-intensive and time-consuming insertion of K-wires to defineprospective trajectories.

Each marker may be received in a hole 276 formed in body 258 (see FIG.7). The hole may, for example, be a blind hole that is open at the top(or the bottom) of guide body 258. During guide construction, the markermay be placed into the hole and held in place therein by any suitablemechanism. For example, the marker may be press-fitted, secured with anadhesive or by bonding, held by threaded engagement with the body or byswaging the body around/over the marker, or the like. In any event, themarker may be attached such that the marker is fixed to the guide body.

The marker may be elongate and may have a diameter that is less thanthat of larger openings of the guide block (e.g., openings 262-268). Forexample, the marker may have a diameter of less than about 2 mm or 1 mm,among others. In other words, the marker may have a diametercorresponding to that of a K-wire. The marker may be substantiallycylindrical and/or linear and may have chamfered ends to facilitateplacing the marker into the body and/or swaging the body over/around theend of the marker during construction of the guide block. The marker maybe described as a pin and/or a post.

The guide block may include any suitable number of markers. Here, threemarkers are shown. A pair of distal markers 252, 254 are parallel to oneanother and parallel to distal small openings 260 and to a row of largerdistal openings 262-265 of guide block 250. Styloid marker 256 definesan axis 278 that may be coplanar with (and, optionally, parallel to) anaxis 280 defined by first styloid opening 267 (and/or second styloidopening 268) of the guide block, through which styloid screw 70 isplaced into radial styloid 122 of the distal radius (see FIGS. 4 and6-8).

FIG. 8 shows a side view of guide block 250. Markers 252, 254 can help asurgeon predict, in fluoroscopic images taken along orthogonal axes,where the entire distal row of bone screws will be implanted in a bone.For example, distal markers 252, 254 may collectively define a distalboundary plane along a proximal-distal axis for a row of distal screwsplaced into bone along parallel axes, in a linear array, through distalrow of apertures 102-108 of the bone plate (also see FIG. 4). Thesedistal markers allow a surgeon, without insertion of K-wires, to quicklydetermine under fluoroscopy, with a medial-lateral beam axis, whetherscrews inserted into the bone through distal apertures 102-108 willenter the joint. In other words, the boundary plane indicates, in aradiographic image, whether and/or how closely bone screws placed intodistal apertures 102-108 will approach or cross the radiocarpalarticular surface of the radial bone. This reduces surgery time byavoiding placement of K-wires to check screw trajectory. Because thereare two markers 252, 254 located near the distal ulnar and distal radialcorners of the guide (see FIG. 6), these markers also help the surgeonpredict the medial and lateral boundaries of screw placement. With abeam axis oriented generally parallel to markers 252, 254, these markersmay appear as dots rather than line segments in radiographic images,while styloid marker 256 may appear as a line segment.

Styloid marker 256 may extend obliquely in guide block 250 to enableprediction of the trajectory of styloid screw 70 into radial styloid 122of radial bone 64 (see FIGS. 4, 6, and 8). Marker 256 can be used duringfluoroscopy with, for example, an anterior-posterior beam axis whilepositioning the plate, such as with handle 56 (e.g., see FIG. 1), tocorrectly orient the plate with respect to radial styloid 122 prior tosecuring the plate to bone. In some embodiments, when marker 256 pointsto the tip of radial styloid 122 in a radiographic image generated witha beam axis orthogonal to the bone plate, the bone plate is positionedcorrectly and correct styloid screw placement can be ensured. However,any other suitable anatomical landmark(s) on any suitable bone may beused as a target for marker 256. Exemplary landmarks include a processor a fossa, among others.

FIG. 9 shows a side view of guide block 250 taken along an axis that isskewed slightly from that of FIG. 8. The side view is orthogonal to eachof distal markers 252, 254 but oblique to a plane defined by thesemarkers. As a result, distal markers 252, 254 are parallel, with endsaligned, but spaced from one another in this view. Accordingly, in aradiographic image collected with the same viewing axis, distal markers252, 254 would form a pair of line segments with a spacing determined bythe angular offset of the viewing angle from the markers' collectivelydefined plane. Therefore, the shape and relative position (coincident,overlapped, or resolved; offset from each other along their long axes oraligned longitudinally) of distal markers 252, 254 in radiographicimages may be used to determine whether the viewing axis is in theintended direction or skewed therefrom.

FIG. 10 shows a bottom view of guide block 250. Inner surface 274 of theguide block and/or guide body 258 may be contoured to be at leastgenerally complementary to outer surface region 240 of the bone plate(also see FIG. 6). Feet 290 may be formed on inner surface 274 toelevate the inner surface slightly from the outer surface region of thebone plate. The guide block may be equipped with at least one matingprojection, such as a flange 292, that projects from inner surface 274.The mating projection may be configured to be received in an aperture ofthe bone plate, to mate the guide block with the bone plate. Forexample, flange 292 may be shaped, sized, and positioned to be receivedin access port 128 of the bone plate (also see FIG. 4). Flange 292 mayor may not extend around the base of largest opening 270 of guide block250. In any event, the mating projection(s) may allow the bone plate andthe guide block to mate with one another along an axis transverse to theplane of the bone plate, such that the openings of the guide block areadjacent to and correctly aligned with apertures of the bone plate andsuch that relative pivotal motion of the bone plate and guide block isrestricted. The guide block can be fastened to the bone plate usingfastener 58 received in any of the larger openings of the guide blockand locked to the bone plate (e.g., by threaded engagement with anaperture of the bone plate). Fastener 58 may have any of the featuresdisclosed for fastener 60 (e.g., see FIG. 5).

FIG. 11 shows a sectional view of radial bone 64, bone plate 52, andguide block 250 taken through distal aperture 104 of the bone plate anddistal opening 263 of the guide block. The distal aperture and thedistal opening may be coaxial to each other and may have about the samediameter. Foot 290 may elevate the guide block from the bone plate toform a gap 300 between the bone plate and the body of the guide block.The gap may be less than (as shown here), about the same as, or greaterthan the thickness of the bone plate. Also, the thickness of the guideblock may be greater than the thickness of the bone plate, such as atleast about two or four times greater, among others.

Guide block 250 may receive a guide tube 302 in any of openings 262-268of the guide block. The opening, such as opening 263 shown here, mayhelp to orient and support the guide tube. Tube 302, which may bedescribed as a cannula, defines a longitudinal through-bore 304, whichmay be sized to receive a drill bit 306 of a drill 308. The guide tubemay have a body 309 that is sized to fit snugly into opening 263 andextend into a counterbore 310 of aperture 104. The guide tube also mayhave a nose 312 of smaller diameter that is sized to be received in alower, threaded region 314 of aperture 104.

V. COMPOSITION OF SYSTEM COMPONENTS

The bone plate, targeting guide, handle, and fasteners disclosed hereinmay be formed of any suitable biocompatible material(s). Exemplarybiocompatible materials include (1) metals (for example, titanium ortitanium alloys, alloys with cobalt and chromium (cobalt-chrome),stainless steel, etc.); (2) plastics/polymers (for example, ultra-highmolecular weight polyethylene (UHMWPE), polymethylmethacrylate (PMMA),polytetrafluoroethylene (PTFE), polyetheretherketone (PEEK), nylon,polypropylene, and/or PMMA/polyhydroxyethylmethacrylate (PHEMA)); (3)ceramics (for example, alumina, beryllia, and/or zirconia, amongothers); (4) composites (e.g., a polymer matrix (such as PEEK)containing carbon fibers and/or ceramic); (5) bioresorbable(bioabsorbable) materials or polymers (for example, polymers ofα-hydroxy carboxylic acids (e.g., polylactic acid (such as PLLA, PDLLA,and/or PDLA), polyglycolic acid, lactide/glycolide copolymers, etc.),polydioxanones, polycaprolactones, polytrimethylene carbonate,polyethylene oxide, poly-β-hydroxybutyrate, poly-β-hydroxypropionate,poly-δ-valerolactone, other bioresorbable polyesters, etc.; and/or thelike.

In exemplary embodiments, the bone plate is formed of metal (e.g.,titanium or a titanium alloy or stainless steel, among others), theextension portion of the handle is also formed of metal (e.g., stainlesssteel or titanium alloy, among others), and the targeting guide has aplastic/polymer body carrying one or more metal markers (e.g., titanium,titanium alloy, or stainless steel, among others). The bone plate,handle, and markers may be formed of materials having differentradiopacities (i.e., different abilities to block X-rays), such as abone plate formed of titanium or a titanium alloy, and a handleextension portion and markers formed of stainless steel.

The ability of a given element to block X-rays is generally proportionalto its mass cubed. Also, the blocking ability of a structure formed ofthe element is generally proportional to the intrinsic blocking abilityof the element multiplied by the characteristic dimension of thestructure measured parallel to the beam axis (e.g., the structure'sthickness or width).

VI. METHODS OF BONE PLATE POSITIONING, ATTACHMENT TO BONE, AND BONEFIXATION

The systems disclosed herein may provide a method of bone fixation,situating a bone plate on bone, and/or attaching a bone plate to bone.The method may include any combination of the steps disclosed in thissection or elsewhere in the present disclosure, performed in anysuitable order.

A bone plate may be disposed on any suitable bone, such as a long bone.Exemplary bones include a bone of the arms (such as a humerus, a radius,and/or an ulna), a bone of the legs (such as a femur, a tibia, and/or afibula), a bone of the hands (such as a carpal, metacarpal, and/orphalange), a bone of the feet (such as a tarsal, metatarsal, and/orphalange), a clavicle, a rib, a scapula, a pelvic bone, a vertebra, askull, a mandible, or the like. Particular bones that may be suitableare a distal part or end region of the radius or tibia, among others.The bone may include a discontinuity, such as a fracture, a cut (e.g.,as a result of an osteotomy), a deformation, a structural instability,or the like.

A targeting guide and/or a handle may be attached to the bone plate toform a bone plate assembly. Attachment of each component may beperformed before or after the bone plate is disposed on the bone. Thetargeting guide and the handle may be connected to the bone plate as aunit or may be connected as discrete, separate components.

The targeting guide may be disposed over an outer surface region of thebone plate such that openings of the targeting guide are adjacent to andin coaxial alignment with the apertures of the bone plate. The targetingguide may include any of the features disclosed herein. For example, thetargeting guide may include a relatively radiolucent body and at leastone relatively radiopaque marker attached to the body.

The handle may be connected to the bone plate at any suitable positionthereof. For example, the handle may be connected near an end of thebone plate or at a central position intermediate opposing end regions ofthe bone plate. The handle, when attached the bone plate, may dispose aradiopaque alignment region parallel and/or coaxial to a long axisdefined by the bone plate and offset orthogonally and longitudinallyfrom the bone plate. As a result, the alignment region may appear as anaxial extension (e.g., a narrower extension) of the bone plate inradiographic images taken with a beam axis oriented orthogonal to thebone plate. The axial extension may overlap or be spaced from the boneplate in the images.

The bone plate, bone, targeting guide, and handle, or any combinationthereof, may be imaged radiographically (generally, with X-rays), suchas by fluoroscopy. Radiographic images (e.g., one or more X-ray images)may be generated by detection of X-rays. The bone and bone plateassembly may be viewed using a beam axis oriented orthogonal (and/ortransverse or parallel) to the bone plate and/or to an outer surfaceregion of the bone plate. In some examples, a beam axis for viewing thebone and bone plate assembly radiographically may be selected by placinga landmark of the handle in juxtaposition with (near or overlapping) afeature of the bone plate in one or more radiographic images. The markerof the targeting guide and/or the alignment region of the handle mayform a line segment and/or define an axis in the radiographic images.

A position of the bone plate on the bone may be adjusted (e.g., whileviewed fluoroscopically), during and/or after generation of one or moreradiographic images. Adjustment of bone plate position may be based onthe radiographic image(s). The position may be adjusted by pivoting thebone plate, moving the bone plate translationally, or both. In someembodiments, the position may be adjusted by sliding the bone on asurface region of a bone, such as on volar surface region of a distalpart of a radial bone or on a distal tibial surface region. In somecases, the position of the bone plate may be adjusted if the linesegment formed in one or more images by the guide marker does not pointadequately at a landmark of the bone in the image and/or if an alignmentregion of the handle does not line up sufficiently with the shaft of thebone. Any suitable anatomical landmark of bone may be utilized inconjunction with the guide marker, generally a protrusion (a process) ora recess, such as a tuberosity, a fossa, a condyle, or the like. In somecases, the landmark may be the radial styloid and particularly a tipthereof.

The position of the bone plate may be stabilized by pressing a miniaturecleat of the bone plate into bone, such that the cleat forms andoccupies an indentation in the bone. After stabilization, the bone platemay be imaged additionally, such as with different views (e.g., amedial-lateral view of the bone and/or a transverse view of the boneplate, among others). If the position of the bone plate is acceptable,the position of the bone plate may be stabilized further by placement ofone or more fasteners, such as a K-wire, through one or more aperturesof the bone plate and into bone. If the position of the bone plate isnot acceptable, the cleat may be removed from the indentation, whichpermits the bone plate to be re-positioned on bone, and then the cleatmay be pressed into bone again at one or more other positions.

The bone plate may be secured to the bone by placement of a plurality offasteners through apertures of the bone plate and into bone. Anysuitable fasteners may be used for attaching or securing the bone plateto bone, such as bone screws, wires, or the like.

VII. KITS

The system disclosed herein may be provided as a kit. The kit mayinclude at least one bone plate, a targeting guide, a handle, fasteners(e.g., bone screws and/or wires, among others) to attach the bone plateto bone and/or the targeting guide and/or handle to the bone plate, adrill, guide cannulas, a driver, and/or the like. Any of the componentsof a kit may be supplied in a sterile package. Some of the componentsmay be configured to be re-used (e.g., the drill, guide cannulas,handle, targeting guide, and/or driver) and others may be configured tobe used only once (e.g., the bone plate and fasteners).

VIII. EXAMPLES

The following examples describe additional aspects of exemplary bonefixation systems including a bone plate, a handle, and/or a targetingguide. These examples are intended for illustration and should not limitthe entire scope of the present disclosure.

Example 1 Exemplary Radiographic Images

This example describes exemplary radiographic images that may begenerated with an exemplary bone fixation system disposed on anexemplary bone; see FIGS. 12-14.

Relative radiopacity is indicated in the images by shading, with bone 64being less radiopaque than bone plate 52, which in turn is lessradiopaque than markers 252-256 and extension portion 142 of handle 56.Structures that block X-rays most efficiently are darkest in the images,and would be lightest in negative versions of the images.

FIG. 12 shows an exemplary radiographic image 320 of bone fixationsystem 50 and radial bone 64 (see FIG. 1). Fasteners 58, 60 are notshown to simplify the presentation. Image 320 may be generated using aradiation beam having a beam axis that is orthogonal to a plane definedby bone plate 52, and is directly along an anterior-posterior throughthe bone. A surgeon can find the proper beam axis for the image shown byadjusting the beam axis until there is a visible juxtaposition,indicated at 322, of landmark 220 and edge feature 222.

The surgeon then may refer to markers 252-256 and alignment region 186to check and refine the position of the bone plate on the bone. Markers252, 254 opposingly flank the most medial and lateral positions ofprospective bone screws and thus may be consulted to adjust theside-to-side position of the head portion of the bone plate across thebone. Marker 256 predicts a prospective trajectory 324 of styloid screw70 (also see FIG. 4). Marker 256 appears as a line segment in the image.The line segment points to the tip of radial styloid 122, indicatingproper orientation of bone plate 52 in an anterior-posterior plane. Ifnecessary or desired, the plate can be moved (e.g., pivoted) to changethe prospective screw trajectory, such as by pointing marker 256 moretoward the tip of the radial styloid. Alignment region 186 provides anindicator for centering body portion 80 across the bone. The plate canbe moved (e.g., pivoted) to position alignment region 186 more coaxialto shaft portion 214 of the bone in the image.

FIGS. 13 and 14 show radiographic images 340, 342 taken as indicated inFIG. 12 with respective beam axes 344, 346 that are skewed from eachother. (Marker 256 is not shown in images 340, 342.) In FIG. 13, beamaxis 344 is orthogonal to the beam axis used to generate image 320 ofFIG. 12, and thus is skewed from a plane defined collectively by markers252, 254. (The plane is generally parallel to a radiocarpal articularsurface 348 formed by radial bone 64, which is tilted radially andvolarly with respect to orthogonal to the long axis of the bone.)Accordingly, markers 252, 254 are resolved into two line segments (bars)in image 340, which define axes 350, 352 that are parallel and spacedfrom each other. In image 340, neither axis is an accurate indication ofthe prospective distal boundary of bone screws placed into distalapertures of the bone plate. In FIG. 14, beam axis 346 is orientedparallel to the plane defined by markers 252, 254, and orthogonal toeach of markers 252, 254 (because the markers are not longitudinallyoffset from each other in the image). As a result, axes 350, 352 aresuperposed and provide an accurate indication of the prospective distalboundary of bone screws placed into the distal apertures the bone plate.For example, in FIG. 14, axes 350, 352 are spaced from distal articularsurface 348, which predicts that bone screws placed into the distalapertures of the bone plate will not enter the radiocarpal joint.

Example 2 Selected Embodiments I

This example describes selected embodiments of the present disclosureinvolving a handle, presented as a series of indexed paragraphs.

1. A method of situating a bone plate on bone, comprising: (A)connecting a targeting guide and a handle to a bone plate to form anassembly; (B) detecting one or more radiographic images of the assemblywith the assembly disposed on a surface region of a bone; and (C)positioning the assembly on the surface region based on a pair ofnonparallel axes defined in the images by the targeting guide and thehandle.

2. The method of paragraph 1, wherein the step of positioning theassembly is based on first and second axes arranged obliquely to eachother.

3. The method of paragraph 2, wherein the first axis is defined by arelatively radiopaque pin attached to and disposed in a relativelyradiolucent body of the targeting guide

4. The method of paragraph 2, wherein the first axis is configured toextend near or intersect a landmark of the bone in the images when thebone plate is correctly positioned on the bone.

5. The method of paragraph 2, wherein the second axis is configured tobe substantially aligned with a shaft of the bone in the images when thebone plate is correctly positioned on the bone.

6. The method of paragraph 2, wherein the handle includes an alignmentsection that defines the second axis and that is offset orthogonally andlongitudinally from the bone plate.

7. The method of paragraph 1, wherein the step of detecting includes astep of detecting images taken orthogonally to the bone plate.

8. The method of paragraph 1, wherein the step of detecting includes astep of selecting a viewing direction orthogonal to the bone plate basedon overlap or close approach, in one or more radiographic images, of alandmark of the handle with a feature of the bone plate.

9. The method of paragraph 8, wherein the landmark is a bend in thehandle.

10. The method of paragraph 1, wherein the handle and the targetingguide are connected separately to the bone plate.

11. A method of situating a bone plate on bone, comprising: (A)connecting a targeting guide and a handle to a bone plate to form anassembly; (B) detecting one or more radiographic images of the assemblywith the assembly disposed on a surface region of a bone; and (C)positioning the assembly on the surface region based on an axis definedin the images by the targeting guide, the handle, or both.

12. The method of paragraph 11, wherein the bone plate defines a set oforthogonal axes, wherein the targeting guide includes an elongate,relatively radiopaque member that defines an axis oriented obliquely toeach of the orthogonal axes of the bone plate, and where the step ofpositioning is based on the axis defined by the radiopaque member.

13. The method of paragraph 11, wherein the targeting guide and thehandle are discrete from one another and connected separately to thebone plate.

14. The method of paragraph 11, further comprising a step of selecting adirection of view orthogonal to the bone plate for the step of detectingbased on a relative disposition of the handle and the bone plate in oneor more radiographic images.

15. A method of bone fixation, comprising: (A) fastening a handleassembly to a bone plate defining a long axis, the handle assemblyincluding an extension portion connected to a graspable grip portion,the extension portion providing a radiopaque alignment region that isoffset from the bone plate along the long axis; (B) generating one ormore radiographic images of the alignment region disposed above a shaftportion of a long bone while the bone plate is disposed on an endportion of the long bone that is wider than the shaft portion; (C)adjusting an orientation of the bone plate on the long bone based on arelative alignment of the alignment region and the shaft portion in theradiographic images; (D) securing the bone plate to the long bone; and(E) disconnecting the handle assembly from the bone plate.

16. The method of paragraph 15, wherein the bone plate defines a plane,and wherein the step of generating one or more radiographic images isperformed using a beam of radiation having a beam axis that issubstantially orthogonal to the plane of the bone plate.

17. The method of paragraph 15 or paragraph 16, wherein less thanone-half of a length of the alignment region overlaps the bone platealong the long axis.

18. The method of any one of paragraphs 15 to 17, wherein the long boneis a radial bone, and wherein the end portion is a distal portion of theradial bone.

19. The method of any one of paragraphs 15 to 18, wherein the step ofadjusting an orientation of the bone plate includes a step ofpositioning the alignment region substantially coaxial to the shaftportion of the long bone in at least one of the radiographic images.

20. The method of any one of paragraphs 15 to 19, wherein the alignmentregion is substantially narrower than the bone plate.

21. The method of any one of paragraphs 15 to 20, wherein the alignmentregion is cylindrical.

22. A method of bone fixation, comprising: (A) selecting a bone plateincluding a head portion connected to an elongated body portion, thebody portion being narrower than the head portion and defining a planeand a long axis; (B) fastening a handle assembly to the bone plate, thehandle assembly including an extension portion connected to a graspablegrip portion, the extension portion providing a radiopaque alignmentregion that is offset from the bone plate along the long axis in adirection away from the head portion; (C) generating radiographic imagesof the alignment region disposed above a shaft portion of a long bonewhile the bone plate is disposed on an end portion of the long bone andusing a beam of radiation having a beam axis oriented substantiallyorthogonal to the plane of the bone plate; (D) positioning the alignmentregion to be substantially parallel to the shaft portion of the longbone in one or more of the radiographic images; (E) securing the boneplate to the long bone; and (F) disconnecting the handle assembly fromthe bone plate.

23. The method of paragraph 22, further comprising a step of forming aradiographically visible juxtaposition of a landmark of the extensionportion with an edge feature of the bone plate in one or moreradiographic images, wherein the juxtaposition signifies that the beamaxis is substantially orthogonal to the plane.

24. The method of paragraph 23, wherein the landmark of the extensionportion is created by a bend in the extension portion, a change in widthof the extension portion, an aperture of the extension portion, or acombination thereof.

25. The method of paragraph 23 or paragraph 24, wherein the bone platehas an outer edge that forms a perimeter of the bone plate and has aplurality of inner edges that bound apertures of the bone plate, andwherein the edge feature is created by the outer edge at an end of thebone plate.

26. The method of any one of paragraphs 22 to 25, wherein the bone platehas an end formed by the body portion, wherein the handle assembly isfastened at a site of the bone plate that is spaced from the end suchthat one or more apertures of the bone plate are disposed between thesite and the end, and wherein the extension portion extends along a pathhaving a transverse offset such that the extension member does notobstruct placement of fasteners into the one or more apertures.

27. The method of any one of paragraphs 22 to 26, wherein the step offastening includes a step of installing at least one fastener thatengages the handle assembly and the bone plate.

28. The method of any one of paragraphs 22 to 27, wherein the step ofpositioning includes a step of positioning the alignment region to besubstantially coaxial to the shaft portion of the long bone in one ormore of the radiographic images.

29. A method of bone fixation, comprising: (A) selecting a bone plateincluding a head portion connected to an elongated body portion, thebody portion being narrower than the head portion and defining a longaxis; (B) selecting a handle assembly including a base portion, agraspable grip portion, and an extension portion connecting the gripportion to the base portion, the extension portion providing aradiopaque alignment region; (C) fastening the bone plate to the handleassembly at the base portion with at least one threaded fastener; (D)disposing the bone plate on an end portion of a long bone and thealignment region above a shaft portion of the long bone, with thealignment region and the shaft portion defining respective long axesthat are substantially coplanar to each other; (E) securing the boneplate to the long bone; and (F) disconnecting the handle assembly fromthe bone plate.

30. The method of paragraph 29, wherein less than one-half of a lengthof the alignment region overlaps the body portion of the bone platealong the long axis defined by the body portion.

31. The method of paragraph 29 or paragraph 30, wherein the long bone isa radial bone, and wherein the end portion of the long bone is a distalportion of the radial bone.

32. The method of any one of paragraphs 29 to 31, wherein the alignmentregion defines a long axis that is parallel to the long axis defined bythe body portion of the bone plate.

33. The method of any one of paragraphs 29 to 32, wherein the bone platehas an end formed by the body portion, wherein the handle assembly isfastened at a site of the bone plate that is spaced from the end suchthat one or more apertures of the bone plate are disposed between thesite and the end, and wherein the handle assembly along a path having atransverse offset such that the handle assembly does not obstructplacement of fasteners into the one or more apertures.

34. The method of any one of paragraphs 29 to 33, wherein the alignmentregion is substantially narrower than the bone plate and cylindrical.

35. A system for bone fixation, comprising: (A) a bone plate including ahead portion connected to an elongated body portion, the body portionbeing narrower than the head portion and defining a plane and a longaxis; and (B) a handle assembly configured to be fastened to the boneplate and including an extension portion connected to a graspable gripportion, the extension portion providing a radiopaque alignment region,wherein, when the bone plate is fastened to the handle assembly anddisposed on an end portion of a long bone, the alignment region isoffset from the body portion of the bone plate along the long axis in adirection away from the head portion and is configured to be disposedabove a shaft portion of the long bone and aligned with the shaftportion of the long bone in one or more radiographic images generatedwith a beam of radiation having a beam axis transverse to the plane.

36. The system of paragraph 35, wherein the alignment region isconfigured to be aligned with the shaft portion of the long bone inradiographic images generated with a beam of radiation having a beamaxis substantially orthogonal to the plane.

37. The system of paragraph 35 or paragraph 36, wherein the alignmentregion is configured to be aligned coaxially with the shaft portion ofthe long bone in the radiographic images.

38. The system of any preceding paragraph, wherein the bone plate has aninner surface region contoured to fit onto an end portion of a longbone.

39. The system of paragraph 38, wherein the inner surface region of thebone plate is contoured to fit onto a distal end portion of a radialbone.

40. The system of any preceding paragraph, wherein the alignment regiondefines an alignment axis that is substantially parallel to the longaxis defined by the body portion of the bone plate.

41. The system of any preceding paragraph, wherein the alignment regionis cylindrical.

42. The system of any preceding paragraph, further comprising a threadedfastener configured to fasten the handle assembly to the bone plate.

43. The system of paragraph 42, wherein the threaded fastener is athumbscrew.

44. The system of any preceding paragraph, wherein a landmark of theextension portion is juxtaposed with an edge feature of the bone platein radiographic images collected when the beam axis is substantiallyorthogonal to the plane.

45. The system of paragraph 44, wherein the landmark of the extensionportion is created by a bend in the extension portion, a change in widthof the extension portion, an aperture of the extension portion, or acombination thereof.

46. The system of paragraph 44 or paragraph 45, wherein the bone platehas an outer edge that forms a perimeter of the bone plate and has aplurality of inner edges that bound apertures of the bone plate, andwherein the edge feature is created by the outer edge at an end of thebody portion of the bone plate.

47. The system of any preceding paragraph, wherein less than one-half alength of the alignment region overlaps the bone plate along the longaxis when the handle assembly is fastened to the bone plate.

48. The system of paragraph 47, wherein substantially none of thealignment region overlaps the bone plate along the long axis when thehandle assembly is fastened to the bone plate.

49. The system of any preceding paragraph, wherein the alignment regionis substantially narrower than the body portion of the bone plate.

50. The system of any preceding paragraph, wherein the bone plate has anend formed by the body portion, wherein the handle assembly isconfigured to be fastened at a site of the bone plate that is spacedfrom the end such that one or more apertures of the bone plate aredisposed between the site and the end, and wherein the extension portionextends along a path having a transverse offset such that the extensionmember does not obstruct placement of fasteners into the one or moreapertures.

Example 3 Selected Embodiments II

This example describes selected embodiments of the present disclosureinvolving a targeting guide in the form of a guide block, presented as aseries of indexed paragraphs.

1. A method of bone fixation, comprising: (A) selecting a bone plateincluding an outer surface region and defining a plurality of apertures;(B) selecting a guide block defining a plurality of openings andincluding a radiolucent body and at least one elongated, radiopaquemarker disposed in and affixed to the radiolucent body; (C) attachingthe guide block to the bone plate with the guide block over the outersurface region of the bone plate and such that openings of the guideblock are adjacent to and in coaxial alignment with apertures of thebone plate, wherein attached is performed after the at least one markeris affixed to the radiolucent body; (D) disposing the bone plate onbone; (E) securing the bone plate to the bone with fasteners placed inone or more of the apertures of the bone plate; and (F) disconnectingthe guide block from the bone plate.

2. The method of paragraph 1, further comprising a step of forming oneor more holes in the bone that are coaxial with one or more of theapertures of the bone plate, wherein the step of forming is performedwith the guide block attached to the bone plate.

3. The method of paragraph 2, wherein the step of forming one or moreholes is performed by installing one or more self-drilling fastenersinto the bone.

4. The method of any one of paragraphs 1 to 3, wherein the step ofsecuring the bone plate to bone is performed while the guide block isattached to the bone plate.

5. The method of any one of paragraphs 1 to 4, wherein the step ofattaching the guide block to the bone plate is performed before or afterthe bone plate is disposed on the bone.

6. The method of any one of paragraphs 1 to 5, wherein the step ofattaching the guide block to the bone plate includes a step of attachingthe guide block to the bone plate with a threaded fastener.

7. The method of paragraph 6, wherein the threaded fastener is athumbscrew.

8. The method of any one of paragraphs 1 to 7, further comprising a stepof generating at least one radiographic image of the bone with the boneplate disposed on the bone and attached to the guide block, wherein theradiographic image is generated with a beam of radiation having a beamaxis oriented at least generally orthogonal to a plane defined by thebone plate, and wherein the marker forms a line segment in theradiographic image.

9. The method of paragraph 8, wherein the line segment overlaps the boneplate in the radiographic image.

10. The method of paragraph 9, wherein at least one-half of a length ofthe line segment is disposed inside a perimeter of the bone plate in theradiographic image.

11. The method of any one of paragraphs 8 to 10, wherein the linesegment points to a process of the bone in the radiographic image.

12. The method of paragraph 11, wherein the line segment points to astyloid process on a radial bone in the radiographic image.

13. The method of any one of paragraphs 1 to 12, further comprising astep of moving the bone plate with respect to the bone based on aposition of the line segment marker relative to the bone in the one ormore radiographic image.

14. The method of any one of paragraphs 1 to 13, wherein the marker isaffixed substantially permanently to the radiolucent body.

15. A method of bone fixation, comprising: (A) disposing a bone plate ona bone, the bone plate including an outer surface and defining aplurality of apertures that extend through the bone plate from the outersurface; (B) attaching a guide block to the bone plate with the guideblock over the outer surface such that openings of the guide block arein coaxial alignment with the apertures of the bone plate, the guideblock including at least one elongated, radiopaque marker disposed inand affixed to the radiolucent body; (C) generating at least oneradiographic image of the bone with the bone plate disposed on the boneand the guide block attached to the bone plate; (D) adjusting a positionof the bone plate on the bone based at least in part on a position ofthe marker with respect to the bone in the radiographic image; and (E)securing the bone plate to the bone.

16. A method of bone fixation, comprising: (A) selecting a bone platedefining a plurality of apertures and a guide block including aradiolucent body defining a plurality of openings and also including atleast one elongated, radiopaque marker disposed in and affixed to theradiolucent body, the guide block being attached or attachable to thebone plate such that openings of the guide block are adjacent to and incoaxial alignment with apertures of the bone plate; (B) generating oneor more radiographic images of the bone with the bone plate disposed onthe bone and attached to the guide block, wherein, in at least one ofthe radiographic images, the marker defines an axis parallel to aprospective trajectory of a fastener extending coaxially to an apertureof the bone plate into the bone; (C) securing the bone plate to thebone; and (D) disconnecting the guide block from the bone plate.

17. The method of paragraph 16, wherein the marker defines an axis thatis substantially coaxial to the prospective trajectory in the at leastone radiographic image.

18. The method of paragraph 16 or paragraph 17, wherein the bone is aradial bone, and wherein the axis intersects the radial styloid of theradial bone in the at least one radiographic image.

19. The method of paragraph 16, further comprising a step of adjusting aposition of the bone plate on the bone based on a position of the axiswith respect to the bone in the at least one radiographic image.

20. The method of paragraph 19, wherein the step of adjusting includes astep of adjusting a position of the bone plate such that the markerpoints to a tip of a process formed by the bone in at least one other ofthe radiographic images.

21. The method of any one of paragraphs 16 to 20, wherein the bone platedefines a plane, wherein the at least one radiographic image isgenerated using a beam of radiation having a beam axis oriented at leastgenerally orthogonal to the plane, and wherein at least a majority ofthe marker is disposed inside a perimeter of the bone plate in the atleast one radiographic image.

22. The method of any one of paragraphs 16 to 21, wherein the marker isdistinguishable from the bone plate and the bone plate isdistinguishable from the bone in the at least one radiographic image,and wherein the radiographic images are generated with the at least onemarker disposed completely outside the bone.

23. The method of any one of paragraphs 16 to 22, wherein the at leastone marker includes a pair of elongate, radiopaque markers that areparallel to each other, and wherein the pair of markers overlap eachother in the at least one radiographic image.

24. The method of paragraph 23, wherein the step of generating isperformed using a beam of radiation having a beam axis, furthercomprising a step of moving the beam axis, the bone, or both, toincrease an amount of overlap of the pair of markers in radiographicimages.

25. The method of paragraph 23 or paragraph 24, wherein the pair ofmarkers collectively define a plane that is parallel to prospectivetrajectories of two or more fasteners from a row of two more aperturesof the bone plate into the bone.

26. The method of any one of paragraphs 16 to 25, wherein an opening ofthe guide block is aligned coaxially with the aperture of the boneplate, further comprising a step of forming a hole in the bone that iscoaxial with the opening and the aperture.

27. A method of bone fixation, comprising: (A) disposing a bone plate ona bone, the bone plate including an outer surface region and defining aplurality of apertures; (B) generating at least one radiographic imageof the bone, with the bone plate disposed on the bone and attached to aguide block, with the guide block over the outer surface region suchthat openings of the guide block are adjacent to and in coaxialalignment with the apertures of the bone plate, the guide blockincluding a radiolucent body that defines the openings and at least oneelongated, radiopaque marker disposed in and affixed substantiallypermanently to the radiolucent body; (C) adjusting a position of thebone plate on the bone based on a position of the at least one markerwith respect to the bone in the radiographic image; and (D) securing thebone plate to the bone.

28. The method of paragraph 27, wherein the at least one marker includesa pair of elongated, radiopaque markers that are not parallel to eachother.

29. The method of paragraph 27 or paragraph 28, wherein the at least onemarker includes a pair of elongated, radiopaque markers that areparallel to each other and spaced from each other in a directiontransverse to axes defined by the markers.

30. The method of paragraph 29, wherein the at least one marker includesthe pair of markers that are parallel to each other and anotherelongate, radiopaque marker that is oblique to the pair of markers.

31. The method of any one of paragraphs 27 to 30, wherein the bone plateis formed of metal and the radiolucent body of the guide block is formedof plastic.

32. The method of any one of paragraphs 27 to 31, wherein the bone is aradial bone, wherein the bone plate defines a row of two or more distalapertures, wherein the at least one marker includes first and secondelongate, radiopaque markers that collectively define a plane paralleland adjacent to axes defined by the distal apertures.

33. The method of any one of paragraphs 27 to 32, wherein the step ofgenerating is performed with the at least one marker disposed completelyoutside the bone.

34. A method of bone fixation, comprising: (A) selecting a bone plateincluding an outer surface region and defining a plurality of apertures;(B) selecting a guide block including a radiolucent body defining aplurality of openings and also including at least one elongated,radiopaque marker affixed to the radiolucent body; (C) attaching theguide block to the bone plate with the guide block contacting the outersurface region of the bone plate and such that openings of the guideblock are adjacent to and in coaxial alignment with apertures of thebone plate; (D) disposing the bone plate on bone; (E) adjusting aposition of the bone plate on the bone based on a position of the markerwith respect to the bone in one or more radiographic images; and (F)securing the bone plate to the bone.

35. The method of paragraph 34, wherein the bone is a radial bone,wherein the bone plate defines a row of two or more distal apertures,wherein the at least one marker includes first and second elongate,radiopaque markers that collectively define a plane parallel andadjacent to axes defined by the distal apertures.

36. A bone fixation system, comprising: (A) a bone plate including anouter surface region and defining a plurality of apertures for receivingfasteners that secure the bone plate to bone; and (B) a guide blockattached or attachable to the bone plate with the guide block directlyabove the outer surface region of the bone plate such that openings ofthe guide block are adjacent to and in coaxial alignment with aperturesof the bone plate, the guide block including a radiolucent body thatdefines the openings and also including at least one elongated,radiopaque marker affixed to the radiolucent body.

37. The bone fixation system of paragraph 36, wherein the at least onemarker is affixed substantially permanently to the radiolucent body.

38. The bone fixation system of paragraph 36 or paragraph 37, whereinthe radiolucent body is a single piece.

39. The bone fixation system of any one of paragraphs 36 to 38, whereinthe bone plate includes a wider head portion connected to a narrower,elongated body portion, and wherein the guide block selectively overlapsthe head portion relative to the body portion.

40. The bone fixation system of any one of paragraphs 36 to 39, whereinthe at least one marker includes a marker defining an axis that isadjacent to an opening of the guide block and substantially parallel toand/or substantially coplanar with another axis defined collectively bythe opening and an aperture of the bone plate aligned coaxially with theopening when the guide block is attached to the bone plate.

41. The bone fixation system of any one of paragraphs 36 to 40, whereinthe at least one marker includes a pair of markers defining spaced axesthat are substantially parallel to each other.

42. The bone fixation system of any one of paragraphs 36 to 41, whereinthe bone plate defines a plane, and wherein at least a majority of themarker is disposed inside a perimeter of the bone plate in aradiographic image of the bone, bone plate, and attached guide blockgenerated using a beam of radiation having a beam axis orientedorthogonal to the plane.

43. The bone fixation system of any one of paragraphs to 36 to 42,wherein the bone plate has an inner surface region contoured to fit ontoa surface region of a bone, wherein the at least one marker includes amarker configured to point to a feature of the bone in a radiographicimage of the bone taken with the bone plate fitted onto the surfaceregion of a bone, the guide block attached to the bone plate, and usinga beam of radiation having a beam axis oriented transverse to the innersurface region.

44. The bone fixation system of paragraph 43, wherein the feature is atip of a process formed by the bone.

45. The bone fixation system of any one of paragraphs 36 to 44, whereinthe bone plate has an inner surface, and wherein the at least one markerdoes not project substantially from the inner surface when the guideblock is attached to the bone plate.

46. A bone fixation system, comprising: (A) a bone plate including ahead portion and an elongated body portion, the head portion having anouter surface and defining a plurality of apertures for receivingfasteners that secure the bone plate to bone; and (B) a guide blockattached or attachable to the bone plate with the guide block directlyabove the outer surface region of the head portion such that openings ofthe guide block are adjacent to and in coaxial alignment with aperturesof the head portion, the guide block including a one-piece, radiolucentbody that defines the openings and also including at least oneelongated, radiopaque marker affixed substantially permanently to theradiolucent body.

47. The bone fixation system of paragraph 46, wherein the bone plate hasan inner surface region contoured to fit onto a distal surface region ofa radial bone.

48. The bone fixation system of paragraph 46 or paragraph 47, whereinthe at least one marker includes a pair of markers defining spaced axesthat are substantially parallel to each other, wherein the spaced axesare parallel to and spaced from a plurality of axes defined by openingsof the guide block that are configured to be aligned coaxially with arow of two or more apertures of the bone plate, and wherein the spacedaxes collectively define a plane representing a boundary for bone screwsplaced in the row of apertures.

49. The bone fixation system of any one of paragraphs 46 to 48, whereinthe bone plate has an inner surface region contoured to fit onto asurface region of a bone, wherein the at least one marker includes amarker configured to point to a tip of a radial styloid in aradiographic image of the bone taken with the bone plate at leastgenerally fitted onto the surface region of a bone, the guide blockattached to the bone plate, and using a beam of radiation having a beamaxis oriented transverse to the inner surface region.

50. The bone fixation system of paragraph 49, wherein the bone platedefines a plane, and wherein the beam axis is orthogonal to the plane.

51. A method of bone fixation, comprising: (A) disposing a bone plate ona bone, the bone plate including an outer surface region and defining aplurality of apertures; (B) generating at least one radiographic imageof the bone, with the bone plate disposed on the bone and attached to aguide block, with the guide block over the outer surface region suchthat openings of the guide block are adjacent to and in coaxialalignment with the apertures of the bone plate, the guide blockincluding a radiolucent body that defines the openings and at least oneelongated, radiopaque marker disposed in and affixed to the radiolucentbody; (C) adjusting a position of the bone plate on the bone based on aposition of the at least one marker with respect to the bone in theradiographic image; and (D) securing the bone plate to the bone.

52. The method of paragraph 51, wherein, in the at least oneradiographic image, the marker defines an axis parallel to a prospectivetrajectory of a fastener extending coaxially to an aperture of the boneplate into the bone.

53. The method of paragraph 51 or paragraph 52, wherein the markerdefines an axis that is substantially coaxial to the prospectivetrajectory in the at least one radiographic image.

54. The method of any one of paragraphs 51 to 53, wherein the bone platedefines a plane, wherein the at least one radiographic image isgenerated using a beam of radiation having a beam axis oriented at leastgenerally orthogonal to the plane, and wherein at least a majority ofthe marker is disposed inside a perimeter of the bone plate in the atleast one radiographic image.

55. The method of any one of paragraphs 51 to 54, wherein the at leastone radiographic image is generated with the at least one markerdisposed completely outside the bone.

56. A bone fixation system, comprising: (A) a bone plate including anouter surface region and defining a plurality of apertures for receivingfasteners that secure the bone plate to bone; and (B) a guide blockattached or attachable to the bone plate over the outer surface regionof the bone plate such that openings of the guide block are adjacent toand in coaxial alignment with apertures of the bone plate, the guideblock including a radiolucent body that defines the openings and alsoincluding at least one elongated, radiopaque marker affixed to theradiolucent body.

57. The bone fixation system of paragraph 56, wherein the at least onemarker is affixed substantially permanently to the radiolucent body.

58. The bone fixation system of paragraph 56 or paragraph 57, whereinthe at least one marker includes a first marker defining an axis that isadjacent to an opening of the guide block and substantially parallel toand/or substantially coplanar with another axis defined collectively bythe opening and an aperture of the bone plate configured to be alignedcoaxially with the opening.

59. The bone fixation system of any one of paragraphs 56 to 58, whereinthe at least one marker includes a pair of markers defining spaced axesthat are substantially parallel to each other.

60. The bone fixation system of paragraph 59, wherein the spaced axesare parallel to and spaced from a plurality of axes defined by openingsof the guide block that are configured to be aligned coaxially with arow of two or more apertures of the bone plate.

61. The bone fixation system of paragraph 60, wherein the spaced axescollectively define a plane representing a boundary for bone screwsplaced in the row of apertures.

62. The bone fixation system of paragraph 61, wherein the outer surfaceregion defines a plane, and wherein the spaced axes are transverse tothe plane.

63. The bone fixation system of any one of paragraphs 56 to 62, whereinthe bone plate has an inner surface region contoured to fit onto asurface region of a bone, wherein the at least one marker includes amarker configured to point to a feature of the bone in a radiographicimage of the bone taken with the bone plate fitted onto the surfaceregion, the guide block attached to the bone plate, and using a beam ofradiation having a beam axis oriented transverse to the inner surfaceregion.

64. The bone fixation system of paragraph 63, wherein the bone platedefines a plane, and wherein the beam axis is orthogonal to the plane.

65. The bone fixation system of any one of paragraphs 56 to 64, whereinthe bone plate includes a wider head portion connected to a narrower,elongated body portion, and wherein the guide block selectively overlapsthe head portion relative to the body portion.

66. The bone fixation system of any one of paragraphs 56 to 65, whereinthe radiolucent body is formed of plastic and the at least one marker isformed of metal.

67. The bone fixation system of any one of paragraphs 56 to 66, whereinthe bone plate is formed of metal.

68. The bone fixation system of any one of paragraphs 56 to 67, whereinthe guide block is substantially thicker than the bone plate.

69. The bone fixation system of any one of paragraphs 56 to 68, whereinthe bone plate includes a wider head portion connected to a narrower,elongated body portion, and wherein the guide block selectively overlapsthe head portion.

70. The bone fixation system of any one of paragraphs 56 to 69, furthercomprising a thumbscrew configured to attach the guide block to the boneplate.

71. The bone fixation system of any one of paragraphs 56 to 70, whereinthe bone plate defines a plane, and wherein at least a majority of themarker is disposed inside a perimeter of the bone plate in aradiographic image of the bone, bone plate, and attached guide blockgenerated using a beam of radiation having a beam axis orientedorthogonal to the plane.

72. The bone fixation system of any one of paragraphs 56 to 71, whereinthe marker does not project substantially from an inner surface of theradiolucent body.

73. The bone fixation system of any one of paragraphs 56 to 72, whereinthe marker also does not project substantially from an outer surface ofradiolucent body.

74. The bone fixation system of any one of paragraphs 56 to 73, whereinthe bone plate and the marker are each formed of metal.

75. The bone fixation system of any one of paragraphs 56 to 74, whereinthe bone plate is formed substantially of titanium, and wherein the atleast one marker is formed of stainless steel.

76. The bone fixation system of any one of paragraphs 56 to 75, whereinthe bone plate has an inner surface region contoured to fit onto adistal surface region of a radial bone.

77. The bone fixation system of any one of paragraphs 56 to 76, whereinthe bone plate has an inner surface, and wherein the at least one markerdoes not project substantially from the inner surface when the guideblock is attached to the bone plate.

78. The bone fixation system of any one of paragraphs 56 to 77, whereinthe radiolucent body is a single piece.

79. The bone fixation system of any one of paragraphs 56 to 78, furthercomprising a guide tube configured to be received interchangeably inindividual openings of the guide block.

The disclosure set forth above may encompass multiple distinctinventions with independent utility. Although each of these inventionshas been disclosed in its preferred form(s), the specific embodimentsthereof as disclosed and illustrated herein are not to be considered ina limiting sense, because numerous variations are possible. The subjectmatter of the inventions includes all novel and nonobvious combinationsand subcombinations of the various elements, features, functions, and/orproperties disclosed herein. The following claims particularly point outcertain combinations and subcombinations regarded as novel andnonobvious. Inventions embodied in other combinations andsubcombinations of features, functions, elements, and/or properties maybe claimed in applications claiming priority from this or a relatedapplication. Such claims, whether directed to a different invention orto the same invention, and whether broader, narrower, equal, ordifferent in scope to the original claims, also are regarded as includedwithin the subject matter of the inventions of the present disclosure.Further, ordinal indicators, such as first, second, or third, foridentified elements are used to distinguish between the elements, and donot indicate a particular position or order of such elements, unlessotherwise specifically stated.

1. A bone fixation system, comprising: a bone plate including an outersurface region and defining a plurality of apertures for receivingfasteners that secure the bone plate to bone; and a guide block attachedor attachable to the bone plate with the guide block directly above theouter surface region of the bone plate such that openings of the guideblock are adjacent to and in coaxial alignment with apertures of thebone plate, the guide block including a radiolucent body that definesthe openings and also including at least one elongated, radiopaquemarker affixed to the radiolucent body.
 2. The bone fixation system ofclaim 1, wherein the at least one marker is affixed substantiallypermanently to the radiolucent body.
 3. The bone fixation system ofclaim 1, wherein the radiolucent body is a single piece.
 4. The bonefixation system of claim 1, wherein the bone plate includes a wider headportion connected to a narrower, elongated body portion, and wherein theguide block selectively overlaps the head portion relative to the bodyportion.
 5. The bone fixation system of claim 1, wherein the at leastone marker includes a marker defining an axis that is adjacent to anopening of the guide block and substantially parallel to and/orsubstantially coplanar with another axis defined collectively by theopening and an aperture of the bone plate aligned coaxially with theopening when the guide block is attached to the bone plate.
 6. The bonefixation system of claim 1, wherein the at least one marker includes apair of markers defining spaced axes that are substantially parallel toeach other.
 7. The bone fixation system of claim 1, wherein the boneplate defines a plane, and wherein at least a majority of the marker isdisposed inside a perimeter of the bone plate in a radiographic image ofthe bone, bone plate, and attached guide block generated using a beam ofradiation having a beam axis oriented orthogonal to the plane.
 8. Thebone fixation system of claim 1, wherein the bone plate has an innersurface region contoured to fit onto a surface region of a bone, whereinthe at least one marker includes a marker configured to point to afeature of the bone in a radiographic image of the bone taken with thebone plate fitted onto the surface region of a bone, the guide blockattached to the bone plate, and using a beam of radiation having a beamaxis oriented transverse to the inner surface region.
 9. The bonefixation system of claim 8, wherein the feature is a tip of a processformed by the bone.
 10. The bone fixation system of claim 1, wherein thebone plate has an inner surface, and wherein the at least one markerdoes not project substantially from the inner surface when the guideblock is attached to the bone plate.
 11. A bone fixation system,comprising: a bone plate including a head portion and an elongated bodyportion, the head portion having an outer surface and defining aplurality of apertures for receiving fasteners that secure the boneplate to bone; and a guide block attached or attachable to the boneplate with the guide block directly above the outer surface region ofthe head portion such that openings of the guide block are adjacent toand in coaxial alignment with apertures of the head portion, the guideblock including a one-piece, radiolucent body that defines the openingsand also including at least one elongated, radiopaque marker affixedsubstantially permanently to the radiolucent body.
 12. The bone fixationsystem of claim 11, wherein the bone plate has an inner surface regioncontoured to fit onto a distal surface region of a radial bone.
 13. Thebone fixation system of claim 11, wherein the at least one markerincludes a pair of markers defining spaced axes that are substantiallyparallel to each other, wherein the spaced axes are parallel to andspaced from a plurality of axes defined by openings of the guide blockthat are configured to be aligned coaxially with a row of two or moreapertures of the bone plate, and wherein the spaced axes collectivelydefine a plane representing a boundary for bone screws placed in the rowof apertures.
 14. The bone fixation system of claim 11, wherein the boneplate has an inner surface region contoured to fit onto a surface regionof a bone, wherein the at least one marker includes a marker configuredto point to a tip of a radial styloid in a radiographic image of thebone taken with the bone plate at least generally fitted onto thesurface region of a bone, the guide block attached to the bone plate,and using a beam of radiation having a beam axis oriented transverse tothe inner surface region.
 15. The bone fixation system of claim 14,wherein the bone plate defines a plane, and wherein the beam axis isorthogonal to the plane.
 16. A method of bone fixation, comprising:disposing a bone plate on a bone, the bone plate including an outersurface region and defining a plurality of apertures; generating atleast one radiographic image of the bone, with the bone plate disposedon the bone and attached to a guide block, with the guide block over theouter surface region such that openings of the guide block are adjacentto and in coaxial alignment with the apertures of the bone plate, theguide block including a radiolucent body that defines the openings andat least one elongated, radiopaque marker disposed in and affixed to theradiolucent body; adjusting a position of the bone plate on the bonebased on a position of the at least one marker with respect to the bonein the radiographic image; and securing the bone plate to the bone. 17.The method of claim 16, wherein, in the at least one radiographic image,the marker defines an axis parallel to a prospective trajectory of afastener extending coaxially to an aperture of the bone plate into thebone.
 18. The method of claim 15, wherein the marker defines an axisthat is substantially coaxial to the prospective trajectory in the atleast one radiographic image.
 19. The method of claim 16, wherein thebone plate defines a plane, wherein the at least one radiographic imageis generated using a beam of radiation having a beam axis oriented atleast generally orthogonal to the plane, and wherein at least a majorityof the marker is disposed inside a perimeter of the bone plate in the atleast one radiographic image.
 20. The method of claim 1, wherein the atleast one radiographic image is generated with the at least one markerdisposed completely outside the bone.